title: Comparison of general anaesthesia versus regional anaesthesia with sedation in selected maxillofacial surgery: a randomized controlled trial.
abstract: BACKGROUND
  The airway is the foremost challenge in maxillofacial surgery. The major concerns are difficulty in managing the patient's airway and sharing it between the anaesthetist and surgeons. General anaesthesia, with endotracheal intubation, is the commonly used technique for maxillofacial procedures. We assessed the efficacy and safety of a regional block with sedation technique in certain maxillofacial operations, specifically temporomandibular joint (TMJ) ankylosis and mandibular fracture cases, and compared it with conventional general anaesthesia. We compared the time to discharge from the post anaesthesia care unit (PACU) and the occurrence of side effects, as well as surgeon and patient satisfaction with the anaesthetic technique, between the two groups.
  
  
  METHODS
  We enrolled 50 patients of ASA grade 1 or 2, aged 15-50 years, scheduled for maxillofacial surgery (mandibular fracture or TMJ ankylosis). The patients were divided into two groups of 25 each, to receive sedation with a regional block with the use of a peripheral nerve stimulator in group I and general anaesthesia in group II. We observed haemodynamic parameters, intraoperative and postoperative complications and the amount of surgical bleeding in the two groups. Total anaesthesia time, patient and surgeon satisfaction, time to rescue analgesia, the number of rescue doses required, and the time to discharge from the PACU were compared.
  
  
  RESULTS
  The groups were comparable with respect to demographic profile, intraoperative haemodynamic parameters, surgical time, and amount of blood loss. Postoperative pain was assessed using the visual analogue score (VAS). Patients in group I had lower VAS scores after surgery and remained pain-free for longer than those in group II. The mean pain-free interval in group I was 159.12 ± 43.95 min and in group II was 60.36 ± 19.77 min (p < 0.005). Patients in group I required lower doses of rescue analgesia than those undergoing the surgery under general anaesthesia (p < 0.005). Patients receiving regional blocks also had fewer episodes of postoperative nausea and vomiting (p = 0.005). These results led to earlier discharge of patients in group I from the PACU.
  
  
  CONCLUSIONS
  Regional block with sedation is a safe alternative technique for patients undergoing surgery for mandible fracture or TMJ ankylosis, with clear advantages over general anaesthesia.
authors.affiliation: SGPGI, Lucknow, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Global Hospital, Chennai, India. Electronic address: prakhargyan@gmail.com.
authors.forename: Prakhar
authors.initials: P
authors.lastname: Gyanesh
authors.affiliation: Sardar Patel Institute of Medical and Dental Sciences, Lucknow, India.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Nisha
authors.affiliation: GSVM Medical College, Kanpur, India.
authors.forename: Appurva
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Shine Dental Clinic, Lucknow, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Mishra
authors.affiliation: SGPGI, Lucknow, India.
authors.forename: Akhilesh Kumar
authors.initials: AK
authors.lastname: Tiwari
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000844:Ankylosis / Q000601:surgery; D016063:Blood Loss, Surgical; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D061886:Neuromuscular Monitoring / Q000295:instrumentation; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012449:Safety; D013705:Temporomandibular Joint Disorders / Q000601:surgery; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: General anaesthesia; Maxillofacial surgery; Peripheral nerve stimulator; Regional anaesthesia; sedation